Helmet wearing in Kenya: prevalence, knowledge, attitude, practice and implications.

OBJECTIVES: In light of the increasing prevalence of motorcycles on Kenyan roads, there is a need to address the safety of individuals using this mode of transport. Helmet use has been proven to be effective in preventing head injuries and fatalities in the event of a crash. This study aims to understand the prevalence of helmet use as well as knowledge, attitudes, and practices in two districts in Kenya over a 5-year period (2010-2014). STUDY DESIGN: Observational studies on helmet use at randomly selected locations throughout each district were done every quarter to estimate the prevalence of helmet use. Roadside knowledge, attitude, and practice (KAP) surveys were done two times a year in each district. METHODS: Helmet use among motorcycle drivers and passengers in Thika and Naivasha was assessed through systematic observations at randomly selected locations in the two districts between August 2010 and December 2014. Roadside KAP surveys were administered in both sites to motorcyclists in areas where they stopped, including motorcycle bays, petrol stations and rest areas near the helmet observation sites. Secondary analysis of trauma registries was also used. Negative binomial regressions were used to assess trends of helmet wearing among motorcyclists over time, and logistic regressions were used to analyze associated risk factors as well as association with health outcomes among those admitted to the four hospitals. RESULTS: A total of 256,851 motorcycles were observed in the two target districts during the study period. Overall, prevalence of helmet use among motorcycle drivers in Thika and Naivasha across all periods was 35.12% (95% confidence interval [CI]: 34.87%-35.38%) and 37.42% (95% CI: 37.15%-37.69%) respectively. Prevalence of helmet wearing remained similar after the passage of a traffic amendment bill. These results were not statistically significant in either Thika or in Naivasha. Data from the KAP survey showed that respondents recognized the life-saving effect of wearing a helmet, but many did not always wear a helmet because they found it inconvenient/uncomfortable. Analysis of trauma registry data showed that helmet wearing was associated with a significant reduction in head injuries among motorcyclists (adjusted odds ratio: 0.472, 95% CI: 0.327-0.684). CONCLUSIONS: This study highlights the low prevalence of helmet use and documents the potential reduction in the risk of head injuries to motorcyclists if this risk factor was addressed. The passage of a traffic amendment bill showed negligible impact on helmet use. This highlights the need for a multi-faceted strategy that includes media campaigns and widespread enforcement in addition to legislative change for improving helmet use.

Knowledge, attitudes, and practices around drinking and driving in Cambodia: 2010-2012.

OBJECTIVE: Road traffic injuries are a leading cause of disability and death in Cambodia. Economic development has long been associated with rapid increases in road traffic injuries and fatalities. Drink driving is of particular concern in Cambodia. In 2014, the percentage of fatal crashes involving alcohol rose to 17.5% (n = 381), representing a 34.9% (n = 253) increase from 2012. This study aims to illustrate current knowledge, attitudes and practices (KAP) around drinking and driving in three Cambodian provinces. METHODS: A roadside survey of randomly selected road users (aged 18 years and older) was conducted in Phnom Penh, Kandal, and Kampong Speu, Cambodia, between November 2010 and May 2012. Data were collected for five-day periods every 6 months. A survey was administered to assess prevailing knowledge, attitudes, and practices surrounding drink driving. RESULTS: A total of 1187 road users responded to the KAP survey, the majority (49.6%, n = 585) of whom were from Phnom Penh. Males accounted for 96.2% (n = 1142) of respondents; the majority (63.8%, n = 757) were aged 34 years and younger. Despite the belief that drinking and driving would increase the risk of a crash, a significant proportion of respondents (37.1%, n = 438) reported driving within 2 h of drinking alcohol at least once in the 30 days preceding the survey. This proportion was particularly high among males aged 25-34 years at 49.2% (n = 208). Of those who reported drinking and driving, 76.5% (n = 335) indicated they 'felt conscious enough' to drive at the time and 34.0% (n = 149) reported having 'no other available transportation options'. CONCLUSIONS: This study shows that, in general, drinking and driving remains a problem in Cambodia. A multi-pronged, coordinated approach is needed to effectively address this issue. Such an approach ought to include social marketing and public education campaigns, enhanced enforcement, and programs that either limit the number of drinks to drivers or those that provide alternatives to drinking and driving.

Trends in motorcycle helmet use in Vietnam: results from a four-year study.

OBJECTIVES: Helmet use is a major risk factor for road traffic injuries and fatalities. This study sought to determine the state of helmet use in Ha Nam and Ninh Binh provinces in Vietnam, and ascertain knowledge, attitudes, and practices of helmet use over time. STUDY DESIGN: Observational helmet use studies, and roadside knowledge, attitudes, and practice surveys. METHODS: Data were collected through observational helmet use studies at multiple sites in Ha Nam and Ninh Binh provinces over 14 rounds between June 2011 and December 2014. Six rounds of knowledge, attitude, and practice surveys were administered at gas stations between December 2011 and July 2014. Trend analysis and negative binomial regressions were used to analyze trend data. RESULTS: Between June 2011 and December 2014, 301,981 helmet-use observations were conducted in Ha Nam and Ninh Binh. Correct helmet use increased significantly (P < 0.01) in Ha Nam from 34.3% to 76.9% (P < 0.01), while use in Ninh Binh increased from 68.9% to 72.2% (P > 0.05). CONCLUSION: Helmet use has improved statistically significantly in Ha Nam but not in Ninh Binh. Ceiling effects may have limited the scope of improvements in Ninh Binh province.

Burden of fall injuries in Pakistan--analysis of the National Injury Survey of Pakistan.

There are no reliable estimates of the burden of fall-related injuries in Pakistan. To assess this burden and develop an epidemiologic profile for these injuries data from the National injury Survey of Pakistan, a cross-sectional population-based survey on injuries, were analysed to determine incidence and relative risks for fall injury. The annual incidence of fall-related injuries was 8.85 per 1000 population per year (95% CI: 6.8-11.3). The mean and median age of individuals injured by falls was 19 years and 10.5 years respectively. Children under the age of 15 years were at a substantially higher risk of fall injuries. Being a student and farmer/labourer/vendorwere associated with a higher risk for falls compared with unemployed. Fall-related injuries are a health burden in Pakistan, especially in children under 15 years of age. This represents a significant loss of healthy life and requires policies to curb this burden in the population.

Burden of fall injuries in Pakistan - analysis of the National Injury Survey of Pakistan

There are no reliable estimates of the burden of fall-related injuries in Pakistan. To assess this burden and develop an epidemiologic profile for these injuries data from the National Injury Survey of Pakistan, a cross-sectional population-based survey on injuries, were analysed to determine incidence and relative risks for fall injury. The annual incidence of fall-related injuries was 8.85 per 1000 population per year [95% Cl: 6.8-11,3]. The mean and median age of individuals injured by falls was 19 years and 10.5 years respectively. Children under the age of 15 years were at a substantially higher risk of fall injuries. Being a student and farmer/labourer/vendor were associated with a higher risk for falls compared with unemployed. Fall-related injuries are a health burden in Pakistan, especially in children under 15 years of age. This represents a significant loss of healthy life and requires policies to curb this burden in the population

Road traffic injuries in urban Africa and Asia: a policy gap in child and adolescent health.

OBJECTIVE: This study highlights the burden of urban road traffic injuries (RTIs) in children and young adults in South Asia and Sub-Saharan Africa to heighten awareness of current limitations in child health policies, and to direct future research and intervention development. METHODS: Comparative analysis of recent Sub-Saharan Africa and South Asia reviews of RTIs, World Health Organization (WHO) Global Burden of Disease statistics, and the Bangladesh Health and Injury Survey. PARTICIPANTS: Children aged 0-18 years in South Asia and Sub-Saharan Africa reviews, aged 0-14 years in the WHO data, and aged 1-17 years in the Bangladeshi data. RESULTS: Child pedestrians comprise the largest proportion of urban RTI victims. More healthy life years were lost per 1000 children aged 0-18 years in South Asia than Sub-Saharan Africa. Disability-adjusted life years lost per 1000 children aged 0-14 years was greater in Africa than South-east Asia. South-east Asia has the greatest overall incidence of RTIs; however, Africa has poorer reported outcomes for children aged 0-14 years. CONCLUSION: These data sources point to the salience of intervening in RTIs in children to prevent a predicted boom in the RTI burden in children, particularly in the poorest regions of the world. However, child health policies in these regions have not yet embraced RTI, either in research or programmes.